Let's Take On The Daunting Task Of Defeating TB

DELHI, INDIA - JUNE 7: Maniha, 9, a tuberculosis (TB) patient for four months, holds her medication at her home after a counselor from operation ASHA ('hope' in Hindi) visited her to give the medication as she is to weak to walk to a treatment center on June 7, 2011, in New Delhi, India. NGOs such as ASHA set up TB treatment centers in the heart of low income communities and slums attempting to treat TB at the source so patients get their medications close to their homes, decreasing the default rates. Lower default rates decrease the risk of multi drug resistant MDR TB, which develops during treatment of fully sensitive TB when the course of antibiotics is interrupted and the levels of drug in the body are insufficient to kill 100% of bacteria. To prevent this, ASHA counselors implement the Directly Observed Treatment, Short-course (DOTS) program, where the drug providers watch the patient receive each dose of their medication. Inadequate access to safe water, sanitation, poor quality housing with bad ventilation, and overcrowding all contribute to the spreading of TB in urban areas. TB is one of the leading causes of mortality in India, killing 2 people every three minutes, nearly 1,000 every day. India currently has 3.5 million people affected by the disease. ASHA hopes to treat 25,000 patients annually by 2013 with support from the World Health Organization. (Photo by Andrew Caballero-Reynolds/Getty Images)

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One of the most amazing phenomena of our times is how a global crisis or challenge galvanises all of us into action, regardless of political, social, cultural or national boundaries. Today, multiple threats to our existence, particularly in public health, have emerged as common challenges that we must unite to overcome. My belief in this was reaffirmed as I participated in multi-lateral deliberations on tuberculosis (TB) at the 46th Union World Conference on Lung Health in Cape Town, South Africa.

My engagement with TB began three years ago, when the Global Coalition Against TB (GCAT), then known as the National Forum on TB, was instituted in New Delhi. TB was brought to my attention as a disease that affects millions of people every year, and kills hundreds of thousands of people all over the world. What struck me most strongly was the fact that this was no new disease. It was ancient, well-known and familiar, and most importantly, preventable and treatable. It was unacceptable to me and many of my parliamentary and political colleagues that such a disease be allowed to infect and kill our fellow citizens.

Pilot projects in Mumbai, Patna and Mehsana are showing the way forward for addressing TB through public-private partnerships.

The TB bacillus infected 2.2 million Indians in 2014, out of a total incidence of 9.6 million worldwide. This number does not include the "missing million", those patients who are off the radar of officially recorded TB cases. With the highest burden of TB in the world, it thus falls on India to take the most proactive and decisive steps in the global fight to end TB.

While India has indeed taken great strides forward in its campaign for TB prevention, care and control, particularly through the flagship Revised National TB Control Programme (RNTCP), the current rate of TB incidence is proof that we have a lot more to do. India banned the inaccurate serology tests for TB diagnosis in 2012, and declared TB a notified disease in the same year. Questions are now regularly raised in Parliament about the status and progress of the TB programme nationally and in the states. Pilot projects in Mumbai, Patna and Mehsana are showing the way forward for addressing TB through public-private partnerships. At last year's Union conference, the government of India led from the front in calling out to the global TB community to put an end to TB. The RNTCP has also established the Nikshay web portal for TB case notification, accessible to all practitioners across the country. However, there remain gaps in implementation that urgently need to be addressed.

The adoption of best practices from around the globe, including the uptake of state-of-the-art technological platforms, is essential towards the evolution and development of more efficacious TB control strategies. In the course of our participation at the Union Conferences in 2013 and 2014, we at GCAT have been exposed to many inspiring and innovative learnings from across the world, which in turn inform our advocacy activities in India.

This year, the Union Conference brought us to South Africa, a pioneer in innovation for TB prevention and control. Our interactions with leading members of the global TB community, as well as leading policymakers from South Africa, have enriched our understanding of the global TB landscape, and better equipped us to address the disease in India.

We, as citizens of the world, have resolved to make it TB-free by 2035. Post the Union Conference in Cape Town, I approach this daunting target with renewed hope.